SUBSTANCE USE INTOXICATION
Substance intoxication is associated with and without substance use disorders. The most common changes with intoxication include disturbances in wakefulness, attention, thinking, judgment, psychomotor, and interpersonal behaviors (APA, 2013). Specific routes of administration produce rapid absorption into the bloodstream, escalating intoxication effects Diagnosing substance use disorders Substance use disorders occur from mild to severe, based on symptomology and fluctuation of the disease process (APA, 2013). Individuals demonstrate a problematic pattern of substance use that leads to significant impairment as manifested by two or more criteria over 12 months for substance use disorder: ● Substance taken in more significant amounts over a more extended period than was intended. ● Persistent desire or unsuccessful efforts to cut down or control the use of the substance. ● A great deal of time spent in activities to obtain the substance. ● Craving or strong desire to use the substance. ● Recurrent substance use failing to fulfill significant role obligations at work, school, or home. ● Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance. ● Important social, occupational, or recreational activities are given up or reduced because of substance use. ● Recurrent substance use in situations in which it is physically hazardous. Alcohol addiction is a chronic relapsing disorder associated with compulsive drinking (NIAAA, 2021). Alcohol use is a common disorder defined by a cluster of behavioral and physical symptoms and can include withdrawal, tolerance, and craving (APA, 2013). Approximately 69.5% of ages 18 and older reported drinking alcohol in the past year, with 59.4% in the last month (NIAAA, 2022). Alcohol is a potent drug that causes physiological changes in almost every body system. The severity of the disorder is based on the number of diagnostic criteria in a given individual, along with changes in the severity of alcohol use across time, reflected by reductions in the frequency of alcohol consumed (APA, 2013). Alcohol use disorder has a variable course characterized by remissions and relapses (APA, 2013). Alcohol use disorder is associated with increased risks of accidents, violence, and suicide (APA, 2013). Severe alcohol use is associated with comorbid conditions such as depression or other disinhibitions of feelings which contributes to suicide attempts as well as completed suicides (APA, 2013). Other disorders associated with alcohol use disorders include psychosis, bipolar disorders, anxiety disorders, sleep disorders, and neurocognitive disorders (Levin et al., 2013). Addiction cycle in alcohol use disorder Alcohol consumption is linked to health and social consequences interfering in personal relationships, heart and liver disease, cancer, motor vehicle collisions, and violence (NIAAA, 2021). The powerful effects on the brain account for euphoria and pleasurable feelings, increasing the motivation to use substances despite the risk of harm (HHS, 2016). The addiction cycle is based on three concepts: (1) binge/intoxication, (2) withdrawal/ negative effects, and (3) preoccupation/anticipation (NIAAA, 2021). Individuals may experience all stages during the day, over weeks or months: ● Binge/intoxication stage is when an individual experiences a rewarding experience, including euphoria, anxiety reduction, and easing of social interactions. Repeat activation of the basal ganglia reinforces the likelihood of repeated consumption through motivation and routine behaviors. The repeated activation of the basal ganglia changes the way an
and likelihood of patterns of use. Intoxication often begins in the teens and is the first substance-related experience. Withdrawal is usually, but not always, associated with substance use disorders but can occur at any age. Short-acting substances have a higher potential for withdrawal than longer-acting substances. The substance's half-life parallels withdrawal (APA, 2013). ● Continued substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by substance. ● Tolerance: ○ A need for markedly increased amounts of the substance to achieve intoxication or desired effect. ○ A markedly diminished effect with continued use of the same amount of the substance. ● Withdrawal: ○ The characteristic substance withdrawal syndrome. ○ The substance is taken to relieve or avoid the withdrawal symptoms. (Levin et al., 2014) Individuals who demonstrate a chronic loss of control or compulsive use of substances and a wide range of adverse risks (mental, physical, and social well-being) meet the criteria for substance-related disorders (Boland & Verduin, 2022). Standardized screening is important to determine the stage of substance use, consequences, and functional impairment (Paxos & Teter, 2019).
ALCOHOL USE DISORDER
individual responds to stimuli, which triggers powerful urges to consume the substance over time (NIAAA, 2021). ● Negative affect/withdrawal stage occurs when an individual stops drinking and withdrawal symptoms occur. These symptoms can be physical (sleep disturbances, pain, and ill feelings) or emotional (dysphoria, irritability, anxiety, and emotional pain). Negative feelings associated with alcohol withdrawal come from two sources. Diminished activation in the reward system makes it difficult to experience the euphoria associated with everyday living. Increased activation of brain stress contributes to anxiety, irritability, and unease (NIAAA, 2021). The individual consumes alcohol to escape the lows of chronic alcohol use. ● Pre-occupation/anticipation stage occurs when an individual seeks alcohol after abstinence. This stage can be triggered by various factors such as stress, social situations, or environmental associated with previous substance use. These triggers can create a psychological and physiological response in the brain, leading to a strong urge to use alcohol. The prefrontal cortex, responsible for executive function, is compromised in alcohol use disorder (NIAAA, 2021). Alcohol intoxication Alcohol intoxication usually develops over minutes to hours and lasts about several hours (APA, 2013). The first episode of alcohol intoxication likely occurs in the mid-teens, but alcohol use disorder is not identified in the late teens or early 20s. The essential feature of alcohol intoxication is the presence of behavioral or psychological changes, including inappropriate sexual or aggressive behavior, mood lability, impaired judgment, and levels of incoordination that may interfere with the performance of usual activities (APA, 2013). The degree of intoxication increases with the blood alcohol concentration, especially when combined with other sedation producing substances (APA, 2013).
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